The number of pregnant women having four or more ultrasounds during the last two-thirds of their pregnancies has nearly tripled in a decade, according to a study from McMaster University.

In 2006, about 25,000 women in Ontario had four or more ultrasounds during their second and third trimesters, up from about 8,500 in 1996.

The study by lead investigator Dr. John You, assistant professor of medicine and clinical epidemiology and biostatistics at McMaster University, included data from the OHIP billing claims of 1.4 million single-birth pregnancies.

The data did not include confidential information, so You said investigators don't know the reason for the increase. However, he said, some believe there's an "entertainment value" to ultrasounds, especially 3-D ultrasounds.

"I think it's more likely that it's just become very entrenched as part of the pregnancy experience," said You.

Doctors recommend pregnant women have two ultrasounds, which are traditionally performed to detect birth defects, such as Down syndrome.

The total cost of the 3.57 million ultrasounds conducted in that 10-year period was about $232 million, a rough estimate based on OHIP billing claims and the current OHIP fee schedule, said You, an adjunct scientist at the Institute for Clinical Evaluative Sciences.

The cost for the additional ultrasounds was about $30 million.

You found the ultrasound numbers "surprisingly high" given that 80 per cent of pregnancies are considered low risk. He said having additional ultrasounds for some women may actually detract from the pregnancy experience.

"The flip side is that they may be twigging unnecessary anxiety when there are no problems."

Dr. Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, said he's heard of several situations where women have requested an ultrasound simply for entertainment.

"They said they didn't like the picture (from the last one)," said Lalonde.

He said the numbers may also be climbing because doctors fear that if they deny the woman's request and something goes wrong, they may end up being sued.

The Society of Obstetricians and Gynaecologists of Canada has a policy against ordering ultrasounds for non-medical reasons so doctors are placed in an ethical dilemma, Lalonde said. He was surprised at the increase because he said there seems to be a movement toward more natural pregnancies and fewer interventions.

"I guess there is another percentage of the population that wants overtesting," Lalonde said.

There may also be legitimate reasons for the increase, Lalonde said. The growing number of women over 40 having babies and the increasing number of obese women may cause more doctors to order more ultrasounds out of concern for their health.

There is no evidence to show that ultrasounds in any way harm the fetus, said You, adding that perinatal deaths decreased slightly from 1996 to 2006, although it's not known if the decrease is due to the increased ultrasound use. There were six fewer perinatal deaths per 10,000 births in 2006 than in 1996.

You hopes his findings will prompt further studies that show why ultrasounds are on the increase.

"That's a lot of money so the question is: is that good value for the money?" said You.

"When you hear about crowded emergency rooms and cancelled surgeries, there are a lot of other things in the medical system that need attending to.

"Maybe that money could be better used."

The study was published in the Canadian Medical Association Journal, an independent medical journal.

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Ultrasound use on fetuses soars